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The ASC Workload Recommendations for Automated Pap Test Screening: What are They and What "Best Practices" are Recommended for Their Implementation?Moderators: William N. Crabtree, PhD, SCT(ASCP)
Tarik M. Elsheikh, MD

Educational Objectives:
1. The recently adopted ASC productivity recommendations for automated Pap Test screening represent an important milestone in the advent of the Pap Test. These recommendations suggest best practices for implementation and clarification of the FDA guidelines for automated Pap Test screening. The primary objective of this session will be to educate the cytology community as to what the ASC’s recommendations are and how best to apply them in the cytology laboratory setting.
2. To allow a format for the primary stake holders in Pap Test screening the opportunity to comment on the new recommendations. This will be accomplished via a panel of invited experts in Pap Test screening from the following list.

The recently proposed recommendations by ASC represent an important milestone in regulating the cytotechnologist’s workload in automated Pap Test screening. These recommendations were also presented to CLIAC in February 2012. The fact that ASCP, ASCT, PSC, and ASC executive boards have unanimously approved those recommendations further emphasize our professional societies’ critical recognition of our need to address this issue in a timely fashion. But where do we go from here?

60th History of Society and Tribute to Founding PresidentsCredit Hours: 0.5 CME/CMLE

The Little Known Story of the 1952 Founding of the Inter-Society Cytology Council (ISCC)R. Marshall Austin, MD, PhD

Educational Objectives:
1. Learn how the newly formed American Cancer Society promoted the ISCC
2. Learn how Gynecologists and Cancer Prevention experts promoted the ISCC
3. Learn Dr. Papanicoloau’s key contributions in forming and structuring the ISCC
4. Learn how pathologists were very divided about the usefulness of cytology

Papanicolaou’s pioneering publications with Traut at Cornell and subsequent applications there showed the promise of cervical screening, but the limited availability of trained personnel and laboratories hindered generalized introduction of the method after WWII. The newly formed American Cancer Society and the National Cancer Institute sought to promote cervical screening and cancer prevention by supporting training programs and educational materials. Papanicolaou initially resisted widespread promotion of the method, fearing that inadequately trained personnel and substandard testing could discredit the method. The formation of the Inter-Society Cytology Council in 1952 reflected the belief by a leadership coalition that interdisciplinary efforts by gynecologists, cytologists, and pathologists were essential to effective introduction of widespread cervical screening in the US.

The Papanicolaou Award, established in 1958, is the highest Award given by the Society and is presented annually to a physician or PhD member. Recipients are in recognition of meritorious contributions in the field of Cytopathology.

Guest LectureCredit Hours: 0.75 CME/CMLE

Diagnostic Cytology in Veterinary Medicine: What can Human and Veterinary Cytopathologists Learn from Each Other?Leslie Sharkey, DVM, PhD, DACVP

Educational Objectives:
1. Understand the clinical application of diagnostic cytology in veterinary medicine
2. Appreciate species differences as they apply to diagnostic cytology
3. Identify areas of overlap and differences between human and veterinary diagnostic cytology

Cytology is used in veterinary medicine as a rapid, cost-effective, and minimally invasive screening tool for diagnosis of infectious, inflammatory, and neoplastic processes. There is significant overlap between veterinary and human medicine in the cytologic diagnosis of infectious agents, however applications for the diagnosis of neoplasia sometimes vary. Cytologic diagnosis of cutaneous and subcutaneous masses is a common application, with high rates of correlation to histopathologic diagnosis. Some neoplasms are similar in incidence and biological behavior to human counterparts, while others are quite unique, such as direct cellular engraftment of neoplastic cells between individuals.

Educational Objectives:
1. Identify characteristic morphologic features of HPV-related head and neck cancers in cytologic and tissue biopsies of primary and metastatic lesions
2. Confirm viral status by selective use of HPV detection assays
3. Discuss the impact of HPV status on outcome of head and neck cancers and understand its emerging role in clinical decision-making

While the incidence of traditional head and neck squamous cell carcinomas associated with smoking and drinking has decreased in the US, HPV-related squamous cell carcinomas of the oropharynx have increased significantly. The HPV-related cancers are distinctly different from non-HPV-related head and neck squamous cancers in terms of demographic profile, risk factors, clinical behavior, prognosis, and morphology. This session will provide an update on the epidemiology, biology, morphologic features, clinical aspects, and diagnosis of HPV-related head and neck cancers. Issues related to different methods of HPV detection will be addressed. HPV-related cancers have a better prognosis in terms of locoregional control and overall survival than traditional squamous cell carcinomas. The session will include a discussion of therapeutic trials assessing treatment de-escalation for patients with HPV-related cancers given their better prognosis and the significant toxicity of conventional cancer therapy.

George D. Lundberg, MD is a pioneer of the medical Internet. Currently, Editor at Large at MedPage Today and Editor in Chief of Cancer Commons from Collabrx; Dr. Lundberg has had twenty-seven years combined experience as Editor in Chief of JAMA (The Journal of the American Medical Association), 10 AMA specialty journals, AMA News, Medscape, The Medscape Journal and e-Medicine from Web MD. His major professional interests include communication, physician behavior, strategic management and health system reform. A member of the Institute of Medicine of the National Academy of Sciences, Dr. Lundberg is past President of the American Society of Clinical Pathologists, and former chair of the Department of Pathology and Laboratory Medicine and the University of California, Davis School of Medicine. He is a frequent lecturer, radio and television guest. In 2000, the Industry Standard dubbed Dr. Lundberg "Online Health Care's Medicine Man".

George is to talk about medical communications and information in the Internet age.

Educational Objectives:
1. Be updated on the 2012 American Cancer Society (ACS) guidelines for cervical cancer screening
2. Be updated on the recommendations from the 2012 CAP-ASCCP Lower Anogenital Squamous Terminology (LAST) project aimed at standardizing terminology used for reporting histopathology diagnoses of HPV-related mucocutaneous squamous lesions of the lower genital tract
3. Understand the scientific basis behind the ACS and LAST recommendations

This session will provide a review of the major recommendations from two recent consensus conferences (1) The ACS-ASCCP-ASCP Cervical Cancer Screening and Prevention: The Role of Molecular Testing PICSM Conference, which formed the basis of the 2012 American Cancer Society Cervical Cancer Screening Guidelines and (2) The CAP-ASCCP “LAST” Conference on standardizing terminology used for reporting histopathology diagnoses of HPV-related mucocutaneous squamous lesions of the lower genital tract. Publications from both Conferences became available in 2012. Selected recommendations from each of these and their scientific basis will be discussed by experts involved in leading the discussions and publications from these two consensus efforts.

Leopold Koss LectureshipCredit Hours: 1.0 CME/CMLE

KSHV and MCV: Old Themes and New Variations in Human Virus TumorigenesisYuan Chang, MD

Educational Objectives:
1. Understand the concept that viruses do not replicate during persistence in tumor cells. They either maintain latency or lose the ability to replicate as a result of integration or mutation. Virus-caused cancers are biologic accidents
2. KSHV is the cause of 3 human proliferative disorders: Kaposi’s sarcoma, primary effusion lymphomas, and a subset of Castleman’s disease. All 3 express the major viral oncoprotein: Latency Associated Nuclear Antigen (LANA)
3. MCV is a ubiquitous human infection and causes Merkel cell carcinoma. Transformation is dependent of the expression of MCV viral tumor (T) antigen proteins: Large T (LT) and small T (sT)

The ASC provides special awards to outstanding individuals in the field of cytology. The following Awards will be presented throughout the Scientific Sessions of the 60th Annual Scientific Meeting. In addition, the ASC provides awards to support young investigators submitting abstracts to the ASC Annual Scientific Meeting.

The Papanicolaou Award, established in 1958, is the highest award given by the Society and is presented annually to a physician or Ph.D. member. Recipients are in recognition of meritorious contributions in the field of Cytopathology.

The Cytotechnologist Award for Outstanding Achievement, established in 1969, is presented annually to an ASC Cytotechnologist. Selection of the recipient is in recognition of meritorious service or accomplishments to the field of cytology.

2012 Excellence in Education Award: Dr. Ibrahim Ramzy

This Award was established in 1998 and is presented annually to a cytotechnologist or physician member of the ASC. The Award is in recognition of meritorious service or accomplishments in the field of cytopathology education to include the education of cytotechnologists, pathology residents and/or cytopathology fellows.

2012 President’s Award

The President’s Award was established in 1992 and is presented annually to an ASC member. Selection of the recipient is at the discretion of the current ASC President.

Educational Objectives:
1. Demonstrate the current challenges in diagnosis of biliary tract malignancy in biliary brushing specimens, including cholangiocarcinoma, pancreatic carcinoma and metastatic tumors involving the biliary tree
2. Demonstrate the most useful cytomorphologic features for making a definitive diagnosis of malignancy and which features overlap with the findings found in reactive conditions such as biliary stone disease and primary sclerosing cholangitis
3. Define how FISH techniques can be applied to cytology specimens to enhance the diagnostic accuracy of biliary brush cytology for the detection of neoplasms involving the biliary tract

Biliary strictures represent a clinical challenge as they can be associated with inflammatory conditions such as chronic pancreatitis, primary sclerosing cholangitis (PSC) or malignancy (pancreatic carcinoma or cholangiocarcinoma). Patients with PSC are at risk for developing cholangiocarcinoma thus compounding the challenge of determining which strictures are benign or malignant. Biopsy or brush cytology of the structured area has low sensitivity for the detection of malignancy (8-57% from literature review) due to both sampling and interpretation challenges. Fluorescence in situ hybridization (FISH) which detects cells with chromosomal abnormalities consistent with malignancy has been shown to improve the sensitivity of bladder cancer detection in urine cytology specimens. FISH applied to biliary brush specimens at our institution have been shown to also improve the diagnostic sensitivity and specificity for malignancy diagnosis. Currently, both conventional cytology and FISH are performed on all biliary brush specimens at our institution. Clinical follow-up on over 1000 patients with combined cytology and FISH analysis on biliary brush specimens has allowed us to create a statistical risk assessment for malignancy on each specimen based on a combination of patient age, PSC status, cytology result and FISH result. Having this unique data set with paired cytology slides has allowed us to identify cytology cases that were true interpretation errors (FISH positive, excluding sampling error). Analysis of this study set has allowed honing of cytomorphological skills to identify which features are most predictive of malignancy and which are nonspecific in biliary brush specimens. The combined use of both FISH and improved cytology skills has facilitated earlier diagnosis of malignancy offering potential for curative treatment, especially in patients with PSC. The panel luncheon presentation would focus on the most helpful cytomorphologic features for evaluating biliary brush specimens and the benefits of adding FISH analysis to further improve diagnostic accuracy.

Educational Objectives:
1. Present to American cytopathologists the way some European cytopathologists are practicing and envisioning their job
2. Learn from American cytopathologists their own way of practicing and envisioning their job
3. Discuss and compare the respective possibilities and difficulties on both sides of the Atlantic Ocean

This Panel Luncheon Seminar is aimed at presenting to American cytopathologists the way some European cytopathologists are practicing and envisioning their job and to exchange with them about the possibilities and difficulties on both sides of the Atlantic Ocean.

Panel Luncheon Seminar 3Credit Hours: 1.75 CME/CMLE/SAM

Panel Luncheon Seminar with the PresidentsCredit Hours: 1.75 CME/CMLE

The Personal Letters and Life of Dr. George PapanicolaouR. Marshall Austin, MD, PhD

Educational Objectives:
1. Become familiar with the personal background of Dr. Papanicoloau
2. Understand how family relationships shaped Dr. Papanicolaou’s career
3. Understand key early character traits of Dr. Papanicolaou that shaped his career

The letters of Dr. George Papanicolaou, son of a Greek family physician, show that he had ambitious dreams of life on a big stage from a very early age. He resisted his family’s persistent urging to return to his native Kymi to take over his father’s medical practice after graduating from medical school at the University of Athens and instead pursued basic science PhD studies in Germany, at his father’s expense. He then eloped to marry a woman who would become his lifelong unpaid laboratory assistant, instead of marrying the wealthy woman his family had arranged for him to marry. Against his family’s wishes, he emigrated to the US in 1913. His letters to his parents and extended family show complex and often conflicted family relationships. After emigration to the US, he never saw his parents again, returning to Greece only in the late 1950s when his innovation, the Pap smear, had begun to receive worldwide acclaim as medicine’s first effective cancer screening test.

Workshop 1Credit Hours: 1.5 CME/CMLE/SAM

The Challenge of Ensuring Adequacy in the New Era of Targeted Lung Cancer TherapyMichael Thrall, MD
John M. Stewart, MD, PhD

Educational Objectives:
1. Review the underlying factors that are changing demands on cytologists who perform immediate adequacy on lung specimens in the new era of targeted therapies and molecular testing
2. Demonstrate practical approaches for achieving suitable diagnoses while preserving cellular material for additional ancillary studies needed for targeted therapies
3. Correlate cytologic findings from touch preparation with corresponding small biopsies from the lung, with an emphasis on how touch preparations differ from FNA and on pitfalls in adequacy assessment and interpretation
4. Compare and contrast endoscopic ultrasound-guided FNA material with material gathered percutaneously by CT guidance

In recent years, therapeutic options for lung cancer have markedly expanded, with numerous additional targeted drugs currently in the development pipeline. While this offers new hope for patients, it also places an increasing burden on cytologists who now need to provide more information about the morphology of the carcinoma they are examining while preserving cells for vitally important molecular ancillary testing.
The goal of this session is to review cytology material in association with corresponding small biopsies of lung carcinoma. Special emphasis will be placed on emerging diagnostic issues and related problems of ensuring “adequacy”. In the past the main job of the cytologist was just to confirm malignancy and separate small cell carcinoma from non-small cell carcinoma. Usually only a relatively small number of cells and just a single good quality slide would suffice for this limited role. Now this is just the beginning of an ever-more complicated diagnostic algorithm. In many cases immunocytochemistry is now essential, hinging on the ability of the cytology laboratory to perform staining on smears or consistently create good cell blocks. Tips for doing both will be part of the session. In the not-so-distant past, immunocytochemistry algorithms mostly focused on maximizing diagnostic certainty, often resulting in panels of four or more markers to separate adenocarcinoma from squamous cell carcinoma. Now, however, preservation of material for genetic testing is at least as important as subtyping, leading to new recommendations to only use two markers. The most commonly used two-marker panel, p63 and TTF-1, can be difficult to interpret and the implications of various staining patterns, as well as optimal ways to proceed, will be discussed. Depending on the morphology and immunocytochemistry, additional molecular studies including PCR for EGFR and FISH for ALK, may also be needed. The session will briefly review the clinical logic behind all of this testing and the increasingly subtle interaction between morphology and treatment, including the correlation with certain adenocarcinoma subtypes with EGFR and ALK mutations. The various cytology materials that can be used for molecular testing, along with pros and cons of different approaches, such as the use of alcohol-fixed smears as opposed to formalin-fixed cell blocks, will also be elaborated upon, especially with regard to how cytologists can “stretch” limited material so as to maximize the success of all testing modalities and thereby avoid repeat testing and the associated delays.
As oncologists and surgeons push for ever-more specific diagnoses, there is a growing burden on cytologists not just to perform immediate adequacy but to assure that sufficient cells are present for all possible testing. The demand for more material is accelerating the trend toward increasing numbers of CT-guided core biopsies of lung tumors. The cytology of touch preparations, including how it differs from conventional FNA material and pitfalls in correlation with the corresponding biopsy, will be reviewed. EBUS-guided FNA of lung tumors and mediastinal nodes has also become more main stream in recent years as a less invasive means of sampling tumors. A review of this technology and the corresponding cytology challenges, particularly the resultant increase in mediastinal lymph node analysis, will also be included in the session.

Educational Objectives:
1. Generate a cytologic differential diagnosis for various cystic and solid head and neck lesions
2. Recognize the pitfalls in the cytologic diagnosis of common salivary gland lesions
3. Discuss the value of special techniques in the diagnosis of thyroid and salivary gland lesions

This course focuses on the controversial diagnostic and classification challenges that are encountered by the pathologists in the diagnosis of head and neck lesions. The discussion will include cytologic and histologic differential diagnosis of various primary and metastatic lesions. The topics will be discussed in detail by illustrating examples of various benign and malignant lesions, such as bronchial cleft cyst, cystic lymph node metastases, pleomorphic adenoma, adenoid cystic carcinoma and mucoepidermoid carcinoma. The value of special techniques in the diagnosis of these lesions including immunohistochemistry, other ancillary techniques and genetic alterations will also be discussed.

Fine needle aspiration (FNA) biopsy of lymph nodes is the mainstay is often the first step in the diagnosis of primary lymphoproliferative disorders. FNA is being increasingly accepted by most patients and clinicians as a non-invasive method for evaluating lymphadenopathy, and is particularly suited for deep-seated lymph nodes. FNA of lymph nodes has high sensitivity and specificity in distinguishing between benign and malignant lesions. The purpose of this course is to present FNA biopsy of lymphoproliferative lesions and correlative results of ancillary techniques, especially immunophenotyping, in this vast array of reactive and neoplastic entities. In the context of clinical presentations, the aspiration cytomorphologic features of benign and malignant lymphoid disorders will be detailed. The former will include reactive follicular hyperplasia, infectious mononucleosis, Castleman's disease, granulomatous inflammation, Rosai-Dorfman disease, and suppurative lymphadenitis. Both nodal and extranodal neoplastic lymphoproliferative disorders will be presented, Hodgkin lymphoma and the non-Hodgkin lymphomas, from the perspective of the current WHO classification. Correlation with histopathology will be done when relevant. The often-crucial role of immunophenotyping of aspirated material by flow cytometry will be presented including a discussion of both the basics and the necessary details.

Workshop 4Credit Hours: 1.5 CME/CMLE/SAM

The Role of Cytology in Molecular Diagnosis, Prognosis and Patient Management in Lung CancerAndre Moreira, MD, PhD
Anjali Saqi, MD

Educational Objectives:
1. Review current clinical advances in thoracic oncology to bring the participants up-to-date with the concept of target therapy in non-small cell lung cancer (NSCLC), and the challenges for cytopathologists
2. Review the cytomorphological criteria for the diagnosis of NSCLC subtypes and the use of ancillary immunocytochemistry as biomarkers in the evaluation of NSCLC as well as prognostic markers
3. Highlight the importance of preserving critical cytological material for molecular mutation analysis
4. Emphasize the important role of cytopathologists and allied professionals in the management of patients with lung cancer, from the specimen acquisition, diagnosis accuracy, and triage for molecular studies

This session will highlight the clinical importance of a specific diagnosis of adenocarcinoma and squamous cell carcinoma, since these two entities are now treated with different drug regimens. We will explain the importance of detectable molecular alterations and the specific drugs used to treat these patients. We will demonstrate the applicability of an algorithm using commonly used antibodies that can help the participants to make accurate and specific diagnosis of adenocarcinoma and squamous cell carcinoma, while preserving valuable tissue for evaluation of prognostic markers. We will also discuss the use of newly available mutation specific antibodies (EGFR and ALK) in cytology specimen. The information on the reactivity of these antibodies, which can detect mutated proteins, and are crucial for the treating physician in selecting adequate systemic therapy. We will discuss currently used techniques for tissue preservation, the importance of fixatives and adequacy of cytological material for molecular tests.

The majority of patients newly diagnosed with lung cancer present with advanced clinical stage, where systemic therapy is the most common therapeutic option. In these cases, cytology or small biopsy specimens are the only mean of tissue diagnosis. Target therapy, the use of specific drugs to address specific molecular alterations discovered in lung cancer has become one of the most important modalities of systemic therapy. Cytopathologists and allied professionals have become integral to the patient management team by providing accurate diagnosis, providing crucial prognostic information, and participating in the triage of critical diagnostic material for specific molecular tests. This course will provide the participants with practical information on the utilization of resources to reach adequate and accurate diagnosis as well as procurement and management of tissue for molecular tests.

Educational Objective:
1. Provide participants with a framework and practical approach with which to diagnose the most common bone and soft tissue lesions on cytologic and small biopsy specimens
2. Learn how to incorporate clinical and imaging information in the formulation of differential diagnoses
3. Learn how to triage specimens for ancillary studies to facilitate a definitive diagnosis
4. Learn the appropriate and most cost effective use of ancillary techniques (immunohistochmical, karayotyping, molecular, flow cytometry, and histochemical), as well as their application to diagnosis
5. Learn some of the most common diagnostic pitfalls and how to avoid them

Mesenchymal neoplasms are a heterogenous group of lesions with well over 100 recognizable subtypes. Because of their relative scarcity, many diagnosticians find them extremely challenging to diagnose with confidence. However, there is increasing pressure from the medical community to provide more timely and accurate diagnosis on the smallest amount of tissue possible, ranging from fine needle aspiration to core needle biopsy specimen. The purpose of this presentation is to provide cytotechnologists and cytopathologists with a multidisciplinary based paradigm to accurately classify the more frequently encountered benign and malignant bone and soft tissue tumors. The participants will learn a realistic approach to the use of morphology and ancillary techniques in this challenging area, how to triage the specimens, how to avoid diagnostic pitfalls, and how to handle situations when limitations of cytologic techniques preclude a precise diagnosis. The lecture is case-based and interactive. With the use of both a pre and post-lecture test for knowledge assessment, the participants will be able to see the results of their learning immediately. This comprehensive yet practical presentation is suitable for individuals in both community and academic practices.

Educational Objectives:
1. Illustrate the true value of urine cytology in detecting high grade lesions
2. Recognize the pitfalls that could lead to erroneous diagnoses and how to avoid them
3. Explore the role of molecular diagnostics in difficult cases
4. Explain how to perform quality assurance in your own laboratory by correlating cystoscopic findings, cytology and biopsy diagnoses

This workshop is designed to highlight the major role of urinary cytology in correctly diagnosing high grade lesions and how to minimize any false positives by illustrating the various pitfalls such as viral infections, stones, drugs and radiation. The role of molecular testing in urine cytology will be reviewed. An audience response system will be used for polling system will facilitate audience participation in unknown cases.

Educational Objectives:
1. Review the cytomorphology and diagnostic challenges in cytological specimens from thoracic lesions including the lung, lymph nodes, thymus, mediastinal soft tissue, and pleura
2. Understand the various cytological patterns for lesions in the mediastinum including epithelioid, lymphoid, and spindle cell lesions, and how this can help one to formulate a differential diagnosis
3. Recognize and understand how ancillary studies such as FISH and molecular techniques can be applied in thoracic and mediastinal cytopathology

This session will provide a comprehensive review of challenging lesions that can be seen in the thoracic cavity, including mediastinal lymph nodes, soft tissue, lung, and pleura. After a brief introduction and didactic presentation, a case-based approach will be utilized to highlight interesting cases, including challenging mesotheliomas, endobronchial ultrasound guided FNA (EBUS-FNA) cases, and other image-guided FNAs of the lung and mediastinum. The discussion will focus on the cytomorphology, differential diagnosis, and diagnostic pitfalls. In addition, there will be a focus on discussing the ancillary studies and updating the audience on how we utilize these tests in our practice as well as present salient points of the current literature in this area of cytopathology. We will emphasize how fluorescence in-situ hybridization (FISH) and molecular techniques can be applied to thoracic cytological specimens. The cases will highlight common diagnostic dilemmas, including mesothelioma and its variants, non-small cell carcinomas of the lung, neuroendocrine tumors, thymic tumors, spindle cell lesions, and lymphoid lesions.

Educational Objectives:
1. Review digital imaging and its impact on the field of cytopathology
2. Discuss the application of telecytology for immediate on-site evaluation of FNA specimens and consultation
3. Perform live demonstrations of immediate evaluation and consultation using digital images

Advances in digital imaging in pathology and related technologies are impacting the practice of cytopathology resulting in improvements in cytology education, consultation, quality assurance, proficiency assessment, image analysis, research, and remote on-site evaluation. Advances in whole slide scanning now offer images of entire slides digitized with higher resolution and multiple focal planes than before that can be stored and accessed in real time. This allows several individuals to remotely and simultaneously view cases. This workshop will provide a review and interactive session on some of the digital imaging applications currently available for cytopathology, including virtual slides for education or consultation, telecytology for immediate on-site evaluation of FNA specimens, and remote teleconsultation. This workshop will include live demonstrations of telecytology in action through the use of remote access to selected cases over the internet with an interactive and lively participation from the audience. Virtual slides of selected cases with a viewer program on DVD will also be provided to participants.

Educational Objectives:
1. Define the most common techniques for cytologic aspiration of the pancreas with emphasis on endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) and its pitfalls
2. Recognize normal pancreatic cytology, reactive changes associated with chronic pancreatitis and their distinction from ductal adenocarcinoma and other tumors
3. Understand the importance of clinical information (patient demographics, tumor location and radiologic appearance) in the diagnosis and distinction of solid and cystic neoplasms from their mimics
4. Identify key cytologic features that distinguish well and poorly differentiated ductal adenocarcinoma from chronic pancreatitis and other pancreatic tumors
5. Recognize the benefits and limitations of ancillary testing in cytologic diagnosis of pancreatic tumors (including cyst fluid analysis, immunohistochemical and molecular studies)

With recent advances in imaging and interventional techniques such as endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA), there has been a marked increase in preoperative cytologic specimens that cytopathologists and cytotechnologists must evaluate. Changes in terminology and classifications of pancreatic neuroendocrine and mucinous tumors have also added to the new information one must absorb. This course will provide an overview of challenges and practical clues in the cytologic diagnosis of pancreatic specimens. Discussions will include: EUS-guided FNA and its pitfalls, pancreatic adenocarcinoma and its distinction from cytologic mimics, differential diagnosis of solid and cystic pancreatic lesions/tumors and use of ancillary studies in diagnosis. Following this course, you will be able to differentiate pancreatic ductal adenocarcinoma, especially the well differentiated type, from chronic pancreatitis and other neoplasms, evaluate cystic pancreatic tumors more efficiently and use clinical information to help in doing so.

Educational Objectives:
1. Present the current morphologic criteria and terminology for urine cytology
2. Present the rationale behind the FISH analysis in urine specimens, including data on indications, sensitivity and specificity and pitfalls
3. Discuss effective ways to use FISH clinical practice

Urine cytology is a commonly used test with known limitations, which have been used in association or have been replaced by FISH in certain practices. The purpose of the presentation is to discuss the criteria and terminology currently used in urine cytology including its limitations. The presentations will also discuss the advantages and limitations of FISH analysis in urine specimens.

The main aim of this workshop is to bridge the gap between basic histology and cytopathology for cytotechnologist. In the daily screening of cytopathology samples the significance and function of many basic histologic features as compared to cytomorphology seen in smears and monolayer preparations are obscure to the cytotechnologist. This workshop will illustrate and discuss the salient cytologic and architectural features seen in histologic samples of commonly biopsied organs and their presentation in various cytologic preparations. The presentations will also discuss the potential pitfalls in the interpretation of normal cell elements.

Educational Objectives:
1. Understand the utility of cytopathology in the diagnosis of common and rare infectious diseases
2. Recognize morphologic structures and contaminants that may mimic true pathogens
3. Better utilize ancillary studies in the identification of infectious agents

Identifying microorganisms in various cytology specimens can sometimes be difficult. This includes common microorganisms and rare infections. The need to identify infections has become increasingly important in transplant recipients and AIDS patients. Evaluation of both microorganism and the host response to these infectious organisms is important in cytopathology. This workshop will focus on the utility of cytopathology in the diagnosis of infectious disease, with emphasis on the detection and identification of both common and rare microorganisms in various cytological specimens. Cytological techniques of specimen procurement, staining, and the role of ancillary studies for the identification of infectious agents will be discussed.

Educational Objectives:
1. Use a case based approach to highlight the cytomorphology of common and uncommon renal lesions, their pitfalls, and differential diagnoses
2. Discuss diagnostic algorithms based on cytologic findings coupled with ancillary studies and clinical information
3. Discuss the use of ancillary studies in reaching a final diagnosis

FNA and core biopsy of the kidney play an increasingly important role in the management of renal masses and may guides clinicians to select pre-nephrectomy adjuvant therapy, partial or total nephrectomy, chemotherapy, or follow-up. We will present 8 diagnostically challenging cases with clinical findings, cytomorphology, ancillary studies, and surgical pathology/clinical follow up. The cases will cover renal cell carcinoma (clear cell, chromophobe, papillary, medullary, and sarcomatoid), oncocytoma, urothelial carcinoma, angiomyolipoma, lymphoma, and metastatic malignancies. The diagnostic considerations based on FNA and touch prep cytomorphology will be discussed. Current ancillary studies useful in reaching a final diagnosis will also be presented. We will use the following materials in a case based PowerPoint presentation: clinical information, FNA smears/touch preparations (Diff-Quik and Pap stained), H&E stained cell blocks /core biopsies, ancillary studies, and pertinent literature review as applicable.

We will first discuss scenarios in which molecular analytic tools play vital roles in rendering specific cytologic diagnoses as well as providing key therapeutic and prognostic information. Information provided will be based on interactions with oncologists, a large state of the art molecular pathology testing facility, as well as an extensive literature review. Examples include: the subclassification of non-small lung carcinoma; EGFR mutation, KRAS mutation, and ALK rearrangement testing in pulmonary adenocarcinoma; mutational analysis of thyroid neoplasms; and cytogenetic analysis of small blue cell tumors and lymphoproliferative disorders.

We will then poll the audience as to the platforms used for these ancillary studies in their routine practices. Results from the poll will provide a segue into discussing advantages and disadvantages of these platforms, incorporating personal laboratory and research experience, recent publications, and a thorough up-to-date literature review.

Finally, we will provide a holistic, integrated approach for triaging limited cytologic tissue in the laboratory aimed at optimizing both cytologic diagnosis as well as the performance of clinically relevant ancillary studies. Optimal triage will be predicated on the appropriate clinico-pathologic contexts and ensuing molecular techniques to be performed (e.g., PCR-based mutational analysis, signal amplification techniques, and fluorescence in-situ hybridization) as well as the necessity of traditional immunocytochemistry. The advantages and disadvantages of immunocytochemical techniques performed on cell block sections and direct smears will also be discussed.

10:30 am - 12:00 pm

Workshop 16Credit Hours: 1.5 CME/CMLE/SAM

Challenges in Thyroid Cytopathology: Identifying the Problem Areas in the Bethesda Classification and Recognizing the Role of Molecular TestingN. Paul Ohori, MD
Zubair W. Baloch, MD

Educational Objectives:
1. Review the current status of thyroid FNA and challenging aspects of the Bethesda Classification
2. Review the variety of processing methodologies for optimal cytomorphology and molecular testing
3. Review common molecular pathways involved in thyroid neoplasia
4. Discuss how ancillary testing may improve our ability to interpret cytomorphologic alterations
5. Discuss the pathologic and clinical significance of molecular alterations in the context of the Thyroid Bethesda Classification System diagnoses

Integration of ancillary studies to routine cytopathologic analysis has become a common part of diagnostic practice. Recently, the molecular pathways of common thyroid malignancies have become better understood. In particular, point mutations in BRAF and RAS genes and RET/PTC rearrangements are found in over 70% of papillary thyroid carcinomas. Follicular carcinomas are associated with RAS point mutation and PAX8-PPAR gamma rearrangement in approximately 80% of cases. Incorporation of molecular techniques has the potential of refining the cytologic diagnosis of thyroid FNAs. In this session, we will discuss the current standard of thyroid FNA practice and the need for implementing molecular testing. Specific emphasis will be placed on optimal techniques for obtaining samples for molecular studies and the interpretation of molecular results in the context of the Thyroid Bethesda Classification diagnoses. The discussion will include how molecular testing can improve the pre-surgical cytologic practice so that the cytopathologist can better guide the clinicians in managing the patients.